Last week’s post examined one of the most important elements to success for shiftworkers — SLEEP. Studies have shown that catching zzz’s is a cornerstone of maintaining good health as well as patient and personal safety. This time, we’ll chat about another necessity thriving through shiftwork — So kick back, grab a tasty snack and let’s talk about FOOD!

 

food for shiftwork

 

You Are What You Eat

 

Everybody has heard this before – and it’s true, in several ways. Specifically, what you eat can indeed change the way you feel, and how you feel can change the way you perform. 

study from Brazil looked at the dietary patterns of shiftworking truck drivers and assessed their sleepiness. The authors were able to classify the drivers’ eating patterns into three separate categories. They found that the prudent or “healthy” eating group reported significantly less sleepiness. It’s pretty obvious that a truck driver who is more alert is less likely to be involved in an MVC.

Not terribly groundbreaking news, for sure: eating healthy is good for performance. The content of the food is important.

But what about the timing of food consumption?

 

Late Night Eats

 

living with shiftwork

 

Eating late at night has been associated with altered hormone function, such as insulin, glucagon and leptin. This leads to decreased blood sugar control and a higher risk of diabetes and obesity. Lipid metabolism also relies on the circadian rhythm quite heavily, and thus nighttime eating has been linked to elevated triglycerides and cholesterol. 

One study found that each 10% increase in calories consumed between 5 pm and midnight was associated with a 3% rise in serum CRP levels. Chronic inflammation is well-known to be associated with a myriad of disease entities such as diabetes, cancer, cardiovascular illness, arthritis, autoimmune illness, inflammatory bowel disease and various eye disorders. 

Does this mean we can’t eat anything at all when working the night shift? Not exactly.

 

Optimize the Big Meals First

 

living with shiftwork

 

A 2017 study examined whether meal timing for shiftworking nurses impacted cardiometabolic syndrome indicators. It found that regardless of what was actually eaten, an increase in any food consumption overnight was associated with increased lipid levels. 

Rather than to take this to mean we should be eating nothing at all when performing evening or night shiftwork, the more pragmatic interpretation would be that regardless of what shift we are working, we should aim to work our meals into our routine as close to usual timing as possible.

Dinner as a meal can happen later than usual, before going into a night shift. Breakfast could be lighter than usual after the night shift since you’ll be going to bed soon after anyway. Lunch could be after you’ve woken from your morning sleep, giving you plenty of time to digest. The key here is to keep your meals within a more or less similar window during nightshifts as you do during dayshifts, to avoid upsetting your circadian rhythm, and to keep those cholesterol levels nice and low.

 

Snacking for Performance

 

What about actually eating on shift over-night? 

A 2019 Australian study attempted to determine how to optimize what to eat on a night shift to maximize performance. The authors randomized 40 participants to (1) meal, (2) snack, or (3) no food and put them through simulated driving shifts overnight. They found that the snack group showed increased time spent in the safe driving zone, better reaction times, and better memory scores when compared to the full meal group and the non-eating group. The mealtime group, as you may have expected, reported greater sleepiness. The authors thus concluded that eating a large meal during the nightshift impairs cognitive performance and sleepiness above the effects of time of night alone. They furthermore recommended that for improved performance, shiftworkers should opt for a snack at night.

Next time you’re working overnight, try having a small snack. Avoid fatty, fried, spicy or sugary foods since these can cause bloating, heartburn, constipation and flatulence. And nobody wants flatulence.

You want high energy, low glycemic index foods, like soups, nuts and seeds, low sugar protein bars, or yogurts. The importance of hydration cannot be overstated overnight. You can kill two birds with one stone by eating hydrating foods like watermelon, strawberries or cucumbers.

 

Mood = Food

 

 

It’s pretty clear that if you are appropriately watered and fed, you’ll feel less sleepy and may perform better as a result. What is even more interesting is the inverse, which is that how we feel often determines what, how, and when we eat.

I want you to picture this scene with me. It’s Friday night, and you’re finishing a rough evening shift. It’s now 1:30 am because you stuck around to help disposition that one last patient, and then you found you hadn’t charted on another. You finally leave at around 2 am – you change, find your car, and pull out of the parking lot. You had dinner just a few hours ago, but somehow, you’re hungry again. As you leave hospital grounds, you see the golden arches. It’s difficult to look away now. ‘A quick snack,” you tell yourself. You place your order. You wonder if the drive-through worker is judging you. The shame is real, the guilt palpable. A ‘quick snack’ turns into an all-out feast. It’s 3 am now, and you can’t sleep because you’re too full. Full of fast food, but also full of regret.

And that is how your mood can control your food, and how food can control your mood.

A study from 2019 in Australia looked at what factors were associated with shiftworking nurses’ diets. They found that higher levels of stress were associated with a higher energy intake, with a higher percentage of fat and saturated fat. They concluded that dietary interventions for shiftworkers should consider the role of mood and shift type. This is a critical point that is often neglected: we all know that we will be tired and cranky after an evening shift. We already know that it will be difficult to turn down a sugar high or a saturated fat rush afterwards.

Aside from being incredibly, unbelievably motivated, the only countermeasure against this is planning.

 

Anticipation and Preparation

 

living with shiftwork

 

The way to beat fast food and other cheap healthy eats is preparation. We must win the war on 1) convenience, but also 2) satisfaction. Just like sleep, this takes practice. It takes months, if not years, to become an efficient and proficient chef who can mealprep tasty recipes varied in their diversity, yet consistent in quality and flavour. You can certainly get better at it with time and practice. But if you just don’t have the time or can’t be bothered to learn to cook (no judgments!), there are other options out there to save you time and grief.

 

If You Can’t Make It, Buy It

 

There are a ton of mealprep subscription services out there. Some services will deliver you portioned ingredients so that you can cook fresh chef-designed dishes yourself. Others will deliver pre-made meals you can refrigerate or freeze, to eat at home, or take to work. These meals are usually macronutrient-balanced, with different options to choose from depending on any specific fitness goals you may have. And don’t let the word ‘fitness’ deter you – there are options for those with no goals, too. These can be used effectively to cut out junk and fast foods or as a mental deterrent to stopping on the way home for less-than-ideal food.

They do come at the expense of money, but whatever money you spend now will be saved later when you don’t have to pay out of pocket for rehab from your stroke at 45 years old from recurrent, intractable burgers after night shifts.

 

FOOD: TAKE-HOME MESSAGE

 

Food on the night shift

  • Whether on days or on nights, try to keep your meals as close to usual timing as possible for best metabolic health
  • Overnight, try a light snack made from high energy, low glycemic index foods
  • Bonus points for hydrating foods like water-heavy fruits
  • Performance-wise, this is likely better than eating nothing, or a full meal

Eating takes practice

  • The war must be fought against both 1) convenience and 2) satisfaction when it comes to unhealthy foods
  • Efficient, effective meal prep takes practice
  • Subscription meal-kit delivery services can help
  • Fully-prepared meal kits that are tasty yet nutrient-balanced are also available

References

  • Martins AJ, Martini LA, Moreno CRC. Prudent diet is associated with low sleepiness among short-haul truck drivers. Nutrition. 2019 Jul-Aug;63-64:61-68. doi: 10.1016/j.nut.2018.11.023. Epub 2018 Nov 23. PMID: 30933727.
  • Garaulet M, Gómez-Abellán P. Timing of food intake and obesity: a novel association. Physiol Behav. 2014 Jul;134:44-50. doi: 10.1016/j.physbeh.2014.01.001. Epub 2014 Jan 24. PMID: 24467926.
  • Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ, Mosley M, Notterpek L, Ravussin E, Scheer FA, Seyfried TN, Varady KA, Panda S. Meal frequency and timing in health and disease. Proc Natl Acad Sci U S A. 2014 Nov 25;111(47):16647-53. doi: 10.1073/pnas.1413965111. Epub 2014 Nov 17. PMID: 25404320; PMCID: PMC4250148.
  • Morgan LM, Shi JW, Hampton SM, Frost G. Effect of meal timing and glycaemic index on glucose control and insulin secretion in healthy volunteers. Br J Nutr. 2012 Oct;108(7):1286-91. doi: 10.1017/S0007114511006507. Epub 2011 Dec 16. PMID: 22176632.
  • Knutsson A, Karlsson B, Ornkloo K, Landström U, Lennernäs M, Eriksson K. Postprandial responses of glucose, insulin and triglycerides: influence of the timing of meal intake during night work. Nutr Health. 2002;16(2):133-41. doi: 10.1177/026010600201600207. PMID: 12102366.
  • Marinac CR, Sears DD, Natarajan L, Gallo LC, 
  • Breen CI, Patterson RE. Frequency and Circadian Timing of Eating May Influence Biomarkers of Inflammation and Insulin Resistance Associated with Breast Cancer Risk. PLoS One. 2015;10(8):e0136240. Published 2015 Aug 25. doi:10.1371/journal.pone.0136240
  • Oxid Med Cell Longev. 2016;2016:5276130. doi: 10.1155/2016/5276130. Epub 2016 Oct 10.
  • Reid KJ, Baron KG, Zee PC. Meal timing influences daily caloric intake in healthy adults. Nutr Res. 2014 Nov;34(11):930-5. doi: 10.1016/j.nutres.2014.09.010. Epub 2014 Oct 2. PMID: 25439026; PMCID: PMC4794259.
  • Molzof HE, Wirth MD, Burch JB, Shivappa N, Hebert JR, Johnson RL, Gamble KL. The impact of meal timing on cardiometabolic syndrome indicators in shift workers. Chronobiol Int. 2017;34(3):337-348. doi: 10.1080/07420528.2016.1259242. Epub 2017 Jan 20. PMID: 28107043; PMCID: PMC5527274.
  • Gupta CC, Dorrian J, Grant CL, Pajcin M, Coates AM, Kennaway DJ, Wittert GA, Heilbronn LK, Della Vedova CB, Banks S. It’s not just what you eat but when: The impact of eating a meal during simulated shift work on driving performance. Chronobiol Int. 2017;34(1):66-77. doi: 10.1080/07420528.2016.1237520. Epub 2016 Oct 13. PMID: 27736177.
  • Gupta CC, Centofanti S, Dorrian J, Coates A, Stepien JM, Kennaway D, Wittert G, Heilbronn L, Catcheside P, Noakes M, Coro D, Chandrakumar D, Banks S. Altering meal timing to improve cognitive performance during simulated nightshifts. Chronobiol Int. 2019 Dec;36(12):1691-1713. doi: 10.1080/07420528.2019.1676256. Epub 2019 Oct 10. PMID: 31599661.
  • Heath G, Dorrian J, Coates A. Associations between shift type, sleep, mood, and diet in a group of shift working nurses. Scand J Work Environ Health. 2019 Jul 1;45(4):402-412. doi: 10.5271/sjweh.3803. Epub 2019 Feb 26. PMID: 30806474.
  • https://www.mealprepottawa.com/
  • https://www.mealpro.net/

 

 

Authors

  • Dr. Eusang Ahn is a RCPSC Emergency Medicine resident at the University of Ottawa.

  • Dr. Samara Adler is a junior editor for the EMOttawa Blog, and is an FRCPC resident in the Department of Emergency Medicine at the University of Ottawa.